Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $170.32 / $227.52 / $360.84	Facility	26	$170.32	$227.52	$360.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $198.40 / $270.38 / $549.89	Professional		$198.40	$270.38	$549.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $116.73 / $141.13 / $296.88	Professional	26	$116.73	$141.13	$296.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.01 / $102.67 / $194.58	Professional	TC	$79.01	$102.67	$194.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $206.07 / $381.23 / $432.83	Professional		$206.07	$381.23	$432.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $117.97 / $225.77 / $253.14	Professional	26	$117.97	$225.77	$253.14
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $176.40 / $584.34 / $584.34	Facility	26	$176.40	$584.34	$584.34
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $232.98 / $433.61 / $1,793.10	Professional		$232.98	$433.61	$1,793.10
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $151.58 / $267.11 / $1,072.88	Professional	26	$151.58	$267.11	$1,072.88
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $99.26 / $170.92 / $720.23	Professional	TC	$99.26	$170.92	$720.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $185.46 / $366.01 / $643.71	Professional		$185.46	$366.01	$643.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $137.97 / $232.67 / $388.67	Professional	26	$137.97	$232.67	$388.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $97.43 / $160.19 / $258.26	Professional	TC	$97.43	$160.19	$258.26
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $118.73 / $198.20 / $337.23	Facility	26	$118.73	$198.20	$337.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $200.48 / $322.81 / $560.21	Professional		$200.48	$322.81	$560.21
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $113.96 / $184.10 / $320.70	Professional	26	$113.96	$184.10	$320.70
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $85.56 / $139.86 / $239.15	Professional	TC	$85.56	$139.86	$239.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $39.72 / $189.61 / $502.42	Professional		$39.72	$189.61	$502.42
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $186.69 / $255.05 / $258.62	Facility	26	$186.69	$255.05	$258.62
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $169.74 / $212.30 / $266.52	Professional	26	$169.74	$212.30	$266.52
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $115.54 / $136.55 / $185.25	Professional	TC	$115.54	$136.55	$185.25
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $174.86 / $174.86 / $176.40	Facility	26	$174.86	$174.86	$176.40
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $298.37 / $471.43 / $585.38	Professional		$298.37	$471.43	$585.38
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $181.57 / $286.60 / $350.14	Professional	26	$181.57	$286.60	$350.14
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $116.98 / $187.94 / $231.51	Professional	TC	$116.98	$187.94	$231.51
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $946.29 / $946.29 / $1,497.68	Facility	26	$946.29	$946.29	$1,497.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $295.68 / $416.00 / $560.52	Professional		$295.68	$416.00	$560.52
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $178.33 / $251.08 / $340.03	Professional	26	$178.33	$251.08	$340.03
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $117.35 / $162.37 / $221.86	Professional	TC	$117.35	$162.37	$221.86
United Facility/Professional Professional Modifier Low / Median / High Price $264.60 / $392.64 / $633.78	Professional		$264.60	$392.64	$633.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $151.83 / $229.93 / $385.30	Professional	26	$151.83	$229.93	$385.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $107.71 / $161.66 / $258.08	Professional	TC	$107.71	$161.66	$258.08
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $171.99 / $206.07 / $230.23	Professional		$171.99	$206.07	$230.23
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $106.56 / $126.42 / $136.83	Professional	26	$106.56	$126.42	$136.83
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $65.43 / $79.65 / $93.41	Professional	TC	$65.43	$79.65	$93.41